Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario
Informed Decisionmaking: Adverse Effects
Following discussion of the evidence, as well as considering cost and insurance coverage, the patient decides that he would like to try a combination of metformin + glyburide. You would explain to him that this change would increase the possibility of which adverse effect?
Discussion of Answers:
A. Incorrect. Explanation: There is moderate strength evidence that the combination of metformin/second-generation sulfonylurea is associated with a more favorable effect on weight when compared to the previous combination of metformin/thiazolidinedione.
B. Incorrect. Explanation: Evidence does not support this statement.
C. Incorrect. Explanation: Limited evidence suggests that there is not an increased risk for liver injury from the combination of metformin/second-generation sulfonylurea.
D. Correct. Explanation: There is high strength evidence that the combination of metformin/second-generation sulfonylurea is associated with higher levels of mild to moderate hypoglycemia than the combination of metformin/thiazolidinedione. Evidence suggests that sulfonylureas increase risk of hypoglycemia due to their mode of action (increasing insulin secretion). The patient should be cautioned that because of the long duration of action of the currently available sulfonylureas, late hypoglycemia is possible, so he should be diligent about meal times.
E. Incorrect. Explanation: Evidence does not support this statement.
Keywords: informed decisionmaking | adverse effects | combination therapy | type 2 diabetes | hypoglycemia
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
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